Tuesday, 10 April 2007


I read an article, in the Spring 2007 issue of Pendulum, the other day, about proposed changes in the diagnosis of bipolar, led by Prof. Nick Craddock. He is quoted as saying: "We might move towards talking, for example, about bipolar spectrum disorder which would mean that the person is susceptible to ups and downs - but it might include people at the moment who are variously diagnosed as having bipolar I disorder, severe depressions and schizophrenia."

The bipolar guidelines and specifications at the moment are very rigid. You have to be pretty much exactly what's described in a text book in order to be diagnosed. In fact, I sometimes wonder if anyone could be pulled off the street, given five or six handbooks to work with, and do what our psychiatrists do now.

Bipolar disorder is now generally classified according to six types identified by Gerald Klerman, MD, (Psychiatric Annals 17: Jan. 1987):

Bipolar I: Mania and depression.
Bipolar II: Hypomania (less severe mania) and depression.
Bipolar III: Cyclothymic disorders (less severe mania, less severe depression).
Bipolar IV: Hypomania or mania precipitated by antidepressant drugs.
Bipolar V: Depressed patients with bipolar relatives.
Bipolar VI: Mania without depression.

Personally, I would fit Bipolar II. Or, if you want to go further into psychobabble, Bipolar II with rapid cycling and a seasonal pattern (ie. more hypomanic in summer, more depressed in winter). Because of the rapid cycling and the less severe mania, my bipolar wasn't identified, and thus wasn't correctly treated, until two and a half years after I first saw my GP. I was initially diagnosed with depression. Then, over a year later, when I eventually saw a psychiatrist (I demanded to see one), bipolar was raised as a possibility but psychotic depression was preferred. When I went into a psychiatric hospital, they diagnosed depression and suggested a possible personality disorder. It wasn't until I'd been out of hospital several months and saw my new psychiatrist, that bipolar was seen to be likely and I was tried on a mood stabiliser. There was an obvious improvement. Now, it seems to me that had things been done Prof. Craddock's way, it's likely that I'd have been treated for bipolar sooner, or at least it would have been one of the more prominent options. Which is why I favour the scheme. I won't go into everything he says, but it involves treatment that's less reliant on meds, things being more individual and less casebook, and other general sense! Of course, everyone's brain is different but has things in common, and likewise the experience of everyone who is bipolar will have things is common but will also be different.

I intend to write a letter in to Pendulum, saying such. I'd quite like to write an article for them sometime, if they'd let me.

It's clear, though, that as I have progressed towards the bipolar diagnosis, I have become more and more typically casebook bipolar. Is this because casebook bipolar is, you know, what I naturally am, in my adult state, and my adolescence has been progression towards that? Or is it that I've thought I'm bipolar so subconsciously I've gone with it? How effectively can the subconscious "create" symptoms? I mean, I've definitely got them. Take, for example, the diagnostic criteria for hypomania:

A distinct period of persistently elevated, expansive; or irritable mood, lasting throughout at least 4 days, that is clearly different from the usual nondepressed mood.
During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:

  • inflated self-esteem or grandiosity
  • decreased need for sleep (e.g. feels rested after only 3 hours of sleep)
  • more talkative than usual or pressure to keep talking
  • flight of ideas or subjective experience that thoughts are racing
  • distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
  • increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
  • excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g. the person engages in unrestrained buying sprees, sexual indiscretions, or foolish business investments)

The episode is associated with an unequivocal change in functioning that is uncharacteristic of the person when not symptomatic.
The disturbance in mood and the change in functioning are observable by others
the episode is not severe enough to cause marked impairment in social or occupational functioning, or to necessitate hospitalisation, and there are no psychotic features.
The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication, or other treatment) or a general medical condition (e.g. hyperthyroidism).

    Now, let me describe the last week or so: Nothing particularly noticeable at first. Had a rotten cold, but was in a good mood. Wasn't sleeping well, but assumed it was down to the cold. Writing loads, but assumed that was down to the discipline of NaPoWriMo. Flood of ideas, assumed that was because I was a brilliantly creative person (!). Couldn't concentrate to read, but assumed I was being lazy. Night before last, it came to a head. I started to feel out of control and became frightened. I got to sleep finally around 5:30 or 6am. I woke up at 8:10, feeling entirely refreshed and saner, and packed a picnic. My friend and I went shopping. I spent over a hundred pounds that I didn't have. Bought a new mobile phone, and a digital camera. Had my nose pierced on impulse. Then we went to look round our old school. We were out for over eight hours. I wasn't tired, went to bed at the normal time. I slept for 12 hours then, which, for me, isn't excessive, just a good night's sleep. And I feel much more normal today. So: have I been experiencing hypomania, or am I just stupid? I still can't concretrate, but maybe I'm just being lazy. :oP

    1 comment:

    Nicole said...

    You're definitely not lazy.

    And, by the way, I fall into the Bipolar II category. I certainly appreciate the spectrum idea.